Ductal carcinoma in situ (DCIS) is rising in incidence in American women. There is a growing appreciation that DCIS is a complex clinical entity with a highly variable natural history. At the same time, treatment options for women with DCIS have become more complicated. Despite the extensive literature on the psychosocial aspects of invasive breast cancer, there is little known about psychosocial outcomes, decision- making, and health behaviors of women with DCIS. This project will focus on psychosocial outcomes of women with DCIS, with the goal of developing interventions to improve psychosocial outcomes. Over a 3- month period, we will identify a total of 750 women with newly diagnosed DCIS from academic and community health care institutions. It is anticipated that 450 of these women will agree to participate in an observational study. Written questionnaires with follow-up telephone interviews will be used to assess anxiety, depression, risk perceptions, decision-making, use of complementary therapies, and other health behaviors. Women will be reassessed at nine and 18 months following diagnosis. In addition, physicians who provide care to the women in the study will complete a brief survey assessing their attitudes and management approaches to DCIS. The study will investigate the relationship between psychosocial outcomes, patient risk perceptions, clarity of treatment recommendations, and patient satisfaction with the decision-making process. The study also will assess the relationship between physicians' attitudes toward DCIS and patient risk perceptions and satisfaction with care. During the last 18 months of the five-year grant period, a psychosocial intervention will be developed and piloted, with the goal of improving psychosocial outcomes in these women.